Healthcare Provider Details

I. General information

NPI: 1336106525
Provider Name (Legal Business Name): PAUL FRANCIS KENWORTHY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KENNEDY DR # LL4
SOUTH BURLINGTON VT
05403-7152
US

IV. Provider business mailing address

1 KENNEDY DR # LL4
SOUTH BURLINGTON VT
05403-7152
US

V. Phone/Fax

Practice location:
  • Phone: 888-720-5832
  • Fax: 888-965-5114
Mailing address:
  • Phone: 888-720-5832
  • Fax: 888-965-5114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number016-0000975
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: